5-Year Experience of Appendage Closure: More Evidence that Does Not Translate into Clinical Practice

The use of percutaneous left appendage closure increased 3.6-fold from 2011 to 2015, but this volume increase did not entail a significant uptrend of in-hospital events in this “real-world” population in Germany. However, can Germany be considered a real-world setting for Latin America? This question is warranted by the fact that there is no apparent volume increase for this technique in our region, which may be due to its cost or the lack of referral from clinicians to interventional cardiologists.

For Germans, the most important predictors of in-hospital mortality were acute renal failure, pericardial effusion, and peri-procedural ischemic stroke.

The safety and efficacy of percutaneous left appendage closure have been demonstrated in randomized trials and prospective cohort studies, but data from a large number of daily clinical practice patients (at least from Germany) are missing.

This study included and analyzed 15,895 patients between 2011 and 2015. The annual number of procedures went up from 1347, in 2011, to almost four times that number (4932), in 2015. This increase was very significant (p < 0.001).

Read also: Five-Year Outcomes for Appendage Closure.

Patient characteristics changed over time, towards older age and prevalence of comorbidities such as heart failure, chronic obstructive pulmonary disease, and chronic renal insufficiency.

The most important independent predictors of in-hospital mortality were cancer (odds ratio [OR]: 2.49), heart failure (OR: 2.42), stroke (OR: 5.39), acute renal failure (OR: 13.28), pericardial effusion (OR: 5.65), and shock (OR: 45.11). The presence of acute renal failure in relation to this procedure, which uses very little contrast, is of note, while the increased mortality among patients with shock is absolutely unsurprising (even though none of us would even dream of conducting an appendage closure in such a setting).

Conclusion

The use of left appendage closure increased 3.6-fold from 2011 to 2015, with a nonsignificant uptrend of mortality. This was all in a setting where treated patients were significantly more ill. The most important predictors of in-hospital mortality were acute renal failure, pericardial effusion, and peri-procedural stroke.

Original title: 5-Year Experience of In-HospitalOutcomes After Percutaneous Left Atrial Appendage Closure in Germany.

Reference: Lukas Hobohm et al. J Am Coll Cardiol Intv 2019;12:1044–52.

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